Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value Based Reimbursement

Commitment Key to Successful Value-Based Reimbursement Adoption

by Jacqueline Belliveau

It is time for healthcare providers to move past understanding the concept and start the value-based reimbursement adoption process. Otherwise, they may face profitability decreases from operating both fee-for-service and alternative payment...

Data Analytics, Collaboration Critical to MACRA Implementation

by Jacqueline Belliveau

Healthcare providers need to restructure many aspects of their organization for successful MACRA implementation, including data analytics capabilities, financial risk assumption, stakeholder partnerships, and patient engagement strategies, according...

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

by Jacqueline Belliveau

CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The final ruling from the federal agency...

Execs To Continue Value-Based Purchasing Despite Uncertainty

by Jacqueline Belliveau

Despite a possible Affordable Care Act repeal, healthcare executives still plan to stay the course with value-based purchasing implementation and healthcare cost reduction initiatives, a recent BDC Advisors survey reported. Although the C-suite...

Post-Acute Care Costs by Market Affect Bundled Payment Models

by Jacqueline Belliveau

A recent study in Medical Care found that post-acute care variations by healthcare market significantly impacted total episode costs in 30-day hip and knee replacement bundled payment models, suggesting financial strategies should focus on high-utilizers...

CMS Opens Comprehensive Primary Care Plus Apps in 4 Regions

by Jacqueline Belliveau

CMS recently announced that the second round of the Comprehensive Primary Care Plus (CPC+) alternative payment model will launch in four regions in 2018. The four regions are Louisiana, Nebraska, North Dakota, and the greater Buffalo area of...

10 Orgs Call for Medicare Advantage APMs to Qualify for MACRA

by Jacqueline Belliveau

A coalition of ten healthcare industry groups recently urged HHS Secretary Tom Price to weigh risk-based Medicare Advantage alternative payment models the same as Advanced Alternative Payment Models under MACRA. Qualifying participants in MACRA’s...

Key Capabilities for Population-Based Alternative Payment Models

by Jacqueline Belliveau

To succeed in population-based alternative payment models with two-sided financial risk, health systems should embrace assuming the role of the payer and work to get all staff on board with the model, suggested Jackie Selby, a healthcare and...

Execs Say Value-Based Purchasing to Hit Tipping Point by 2020

by Jacqueline Belliveau

Over one-half (55 percent) of healthcare executives surveyed after the recent presidential election stated that the industry should reach the value-based purchasing tipping point before 2020, a recent Lazard report revealed. The survey of 203...

Will Behavioral Economics Improve Alternative Payment Models?

by Jacqueline Belliveau

Alternative payment models may need to account for the behavioral economics behind provider prescribing habits to effectively reduce healthcare costs from expensive medications and treatments, a recent American Journal of Managed Care study stated....

Engaging Providers Key to Value-Based Reimbursement Adoption

by Jacqueline Belliveau

Nearly three-quarters (73 percent) of providers prefer a fee-for-service model over value-based reimbursement structures even though almost one-half acknowledged that the traditional payment model contributed to higher healthcare costs, a recent...

Creating Alternative Payment Models to Support Health Centers

by Jacqueline Belliveau

Healthcare stakeholders and lawmakers should encourage community health centers to engage in alternative payment models to financially incentivize providers to improve safety-net care, a recent Journal of the American Medical Association report...

56% of Top Performing Med Groups Plan Value-Based Purchasing

by Jacqueline Belliveau

About 56 percent of medical groups that were financially high-performing have a plan for a value-based purchasing transition versus just 32 percent of medical groups falling behind with healthcare revenue cycle management, a recent CareCloud...

Post-Acute Care Network Key to Value-Based Purchasing Success

by Jacqueline Belliveau

Health systems should develop a post-acute care network and strategy to succeed in value-based purchasing models, a recent Deloitte survey indicated. The survey of 36 executives from health systems, payers, post-acute care organizations, and...

Bundled Payments, Clinical Pathways Drive Cancer Care Savings

by Jacqueline Belliveau

Early adopters of value-based reimbursement models for oncology realized significant cancer care savings through bundled payments and clinical pathways, a recent Evidence-Based Oncology study revealed. But the financial incentives for the models...

AAFP: Drop MIPS APM Pathway to Simplify MACRA Implementation

by Jacqueline Belliveau

The American Academy of Family Physicians (AAFP) recently urged CMS to simplify MACRA implementation to support primary care provider participation in the Quality Payment Program. The industry group called for several Quality Payment Program...

MIPS Requirements for Clinicians in Small, Rural Hospitals

by Jacqueline Belliveau

In light of the unique challenges eligible clinicians in small and rural hospitals face, CMS developed special Merit-Based Incentive Payment System (MIPS) eligibility and reporting requirements for the clinician group. Through MIPS, CMS aims...

Value-Based Penalties Target Hospitals With High Risk Patients

by Jacqueline Belliveau

Hospitals that serve greater volumes of African-American patients and those with more severe conditions are more likely to receive a value-based penalty under the Medicare Hospital Readmissions Reduction Program (HRRP), a new JAMA Cardiology...

CMS Expects to Release MIPS Participation Status By May 2017

by Jacqueline Belliveau

CMS anticipates notifying eligible clinicians about their Merit-Based Incentive Payment System (MIPS) participation status for 2017 via letter between late April through May, a recent email from the federal agency stated. The announcement (via...

Value-Based Reimbursement Spurs 8% Hospital Merger Growth

by Jacqueline Belliveau

Value-based reimbursement trends drove health system and hospital merger activity to increase 8 percent compared to the first quarter of 2016, Anu Singh, a Managing Director at Kaufman, Hall & Associates, recently told RevCycleIntelligence.com....

Continue to site...